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Updated: May 6, 2026

Establishing a Competing Risk Regression Nomogram Model for Survival Data
Published on: October 23, 2020
Nomogram for Predicting 1-, 3-, and 5-Year Survival in Hemodynamically Significant Aortic Regurgitation: The ARISE
Kang Liu1, Meng-Han Tsai1, Wei-Jyun Wang1
1Department of Internal Medicine and Cardiovascular Center National Taiwan University Hospital Taipei Taiwan.
Background:
A user-friendly tool that integrates key clinical variables to estimate prognosis in aortic regurgitation is lacking. We aimed to develop and validate a nomogram-based score to predict survival and identify high-risk patients for timely aortic valve surgery referral.
Methods And Results:
From 2008 to 2022, 1229 patients (derivation data set: 764 Taiwanese; validation data set: 465 Japanese; age: 64±17 years) with isolated chronic moderately severe to severe aortic regurgitation from 3 centers were included. All echocardiograms were reviewed de novo. At a median follow-up of 5.0 (interquartile range, 2.2-8.2) years, 204 all-cause deaths occurred and 247 underwent aortic valve surgery within 3 months. In multivariable analysis, age (P<0.001), Charlson Comorbidity Index (P<0.001), New York Heart Association functional class IV (P<0.001), left ventricular ejection fraction (P<0.001), left ventricular end-systolic dimension index (P=0.03), and aortic valve surgery in 3 months (P=0.03) were associated with all-cause death. These variables, along with sex and maximal aorta diameter index, were incorporated into the combined left ventricular ejection fraction and left ventricular end-systolic dimension index nomogram to estimate 1-, 3-, and 5-year survival and to calculate the Aortic Regurgitation/Insufficiency Survival Estimation (ARISE) score. Calibration plots demonstrated good performance, with the area under the receiver operating characteristic curve reaching 0.79 in the validation data set. The left ventricular end-systolic dimension index-based nomogram showed similar performance. By using the tertiles of the ARISE score to risk stratify individuals, Kaplan-Meier curves demonstrated significant survival differences among 3 risk groups in both the derivation and validation cohorts (P<0.001).
Conclusions:
The ARISE score (https://arise-score.vercel.app/), which includes guideline-recommended parameters, effectively predicts survival in patients with aortic regurgitation. It may facilitate shared decision-making between the heart team and patients.
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